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Intensive Care and Trauma

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Heart Rate Variability

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Abstract

During the course of the twentieth century, impressive innovations were introduced that improved the treatment of critically ill persons. Such innovations include the identification of the entity “shock” and its treatment by fluid resuscitation in the 1930s, introduction of dialysis in the 1950s, modern respiratory therapy following the big polio epidemics of the 1950s, and improved treatment of respiratory failure in the 1960s. Probably because patients survived such ailments, in the 1970s increased awareness of conditions eventually led to the description of what we now call “multiple organ failure.” The idea of sepsis is much older, but the concept has changed fundamentally over the last decades. Originally, sepsis was associated with the fatal effects of bacteria coming from a certain source and circulating in the blood. As early as in the 1970s, a concept arose which described the fatal effects of sepsis not as consequence of bacterial damage but as consequence of an overreacting immune system. Lewis Thomas wrote 1972 “the microorganisms that seem to have it in for us… turn out… to be rather more like bystanders… It is our response to their presence that makes the disease. Our arsenals for fighting off bacteria are so powerful… that we are more in danger from them than the invaders” (Thomas 1972). In the following years, animal models were developed that led to the description of immunological cascades involving different pro- (and anti-) inflammatory substances. Possible interventions were then outlined and tested on animals, albeit with disappointing results. Until now, only two non-antibiotic medicaments with effect on sepsis survival (see below) have been identified. The concepts did not arise from an increased pathophysiological understanding; rather, pathophysiological concepts changed with the evolution of clinical experience. Enormous evidence about sepsis as a complex syndrome with multiple circuits and feedback mechanisms has been published. Sepsis is perhaps one of the best-described pathological conditions, but there is no qualitative comprehensive model, not even a quantitative temporal model.

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Notes

  1. 1.

    To focus on the complexity of illnesses in the intensive care unit, mathematicians, physicists, and clinicians recently founded a new society on complexity in acute illnesses. See www.scai-med.org.

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  1. Kongsberg Hospital, Kongsberg, Norway

    Gernot Ernst

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Ernst, G. (2014). Intensive Care and Trauma. In: Heart Rate Variability. Springer, London. https://doi.org/10.1007/978-1-4471-4309-3_10

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  • DOI: https://doi.org/10.1007/978-1-4471-4309-3_10

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